Gynaecologe

Non-immune hydrops fetalis may find its origin within genetically determined lymphedema syndromes, caused by mutations in FOXC2 and SOX-18. We describe a newborn girl, diagnosed with non-immune hydrops fetalis at a gestational age of 30 weeks. Family history revealed the presence of an autosomal dominant late-onset form of lymphedema of the lower limbs in her father, associated with an aberrant implantation of the eyelashes in some individuals. The newborn, hydropic girl suffered from severe pulmonary lymphangiectasia, resulting in terminal respiratory failure at the age of 3 months. Genetic analysis in both the father and the newborn girl demonstrated a heterozygous FOXC2 mutation, i.e., c.939C>A, p.Tyr313X. Her two older sisters are currently asymptomatic and the parents decided not to test them for the FOXC2 mutation. Conclusion: Patients with a mutation in the FOXC2 transcription factor usually show lower limb lymphedema with onset at or after puberty, together with distichiasis. However, the eye manifestations can be very mild and easily overlooked. The association between FOXC2 mutation and neonatal hydrops resulting in terminal respiratory failure is not reported so far. Therefore, in sporadic patients diagnosed with non-immune hydrops fetalis, lymphangiogenic genes should be systematically screened for mutations. In addition, all cases of fetal edema must prompt a thorough analysis of the familial pedigree, in order to detect familial patterns and to facilitate adequate antenatal counseling.

Nuchal translucency (NT) measurements were compared between 13 centres participating in a multi-marker Down syndrome screening program. Results from 4765 women were analysed, and there were highly statistically significant between-centre differences after allowing for gestation (P < 0.0001). Examination of maternal serum marker levels, expressed in multiples of the median (MoM) for gestation, showed that this was not due to gestational errors. Regression analysis was carried out to derive an equation with a centre-specific component that could be used to express NT in MoMs. Use of this equation reduced the variance of logNT by 15% compared to a published equation. The equation can be readily modified for use in other centres.

Background: Elective preterm delivery of the fetus with gastroschisis may help to limit injury to the extruded fetal gut and thus promote faster recovery of neonatal gut function and earlier hospital discharge. This hypothesis has not previously been tested in a prospective randomized controlled trial. Methods: Between May 1995 and September 1999, all women referred to a single tertiary center before 34 weeks' gestation with a sonographically diagnosed fetal gastroschisis were invited to participate in a randomized controlled trial. Eligible patients were randomized to elective delivery at 36 weeks or to await the onset of spontaneous labor. The method of delivery was not prescribed by the trial. Primary outcome measures in the neonate were the time taken to tolerate full enteral feeding (150 mL/kg per day) and duration of hospital stay. Results: Of 44 eligible women, 42 were randomized, 21 to elective delivery and 21 to await spontaneous labor. There were 20 liveborn infants in each group. Four babies in the elective group and 4 in the spontaneous group delivered before 36 weeks' gestation but were included in the analysis on an intention-to-treat basis. Mean gestational age at delivery was 35.8 weeks in the elective group and 36.7 weeks in the spontaneous group. Primary closure of the gastroschisis was achieved in a similar proportion (80%-85%) of infants in both groups. Two babies in the elective group died from short gut complications. In the survivors, there was a trend in favor of a shorter median time to achieve full enteral feeding (30.5 vs 37.5 days) and a shorter median duration of hospital stay (47.5 vs 53 days) in the elective group, but this was not statistically significant. These findings remained unaltered when the data were reanalyzed after (a) excluding infants with intestinal atresia or (b) excluding infants born before 36 weeks' gestation. Conclusions: Although limited by the small number of patients, this randomized controlled trial demonstrates no significant benefit from elective preterm delivery of fetuses with gastroschisis. D

Een primigravida zwanger van een monochoriale monoam-niotische (MCMA) tweeling, wordt doorverwezen naar onze MIC-afdeling op een amenorroeduur van 27 weken omwille van premature contracties. De cervixlengte is 15mm. MCMA tweelingen vertegenwoordigen 1% van de mo-nozygote tweelingen. De meest specifieke complicatie is een navelstrengverstrengeling, oorzaak van 50% van de foetale sterftes. Het vaststellen van een navelstreng-verstrengeling is een moeilijke prenatale diagnose (1, 2). Op een amenorroeduur van 29 weken en 5 dagen wordt op 3D color dopplerechografie een verstrengeling van beide navelstrengen vermoed (Figuur 1), alsook een ge-associeerd oligohydramnion (3). Patiënte krijgt 3-maal daags foetale monitoring met dagelijks biofysisch pro-fiel met dopplers. Binnen de 24 uur na echografie zet de premature arbeid zich door en wordt er overgegaan tot dringende sectio caesarea. De navelstrengverstrengeling wordt bevestigd (Figuur 2). Twee meisjes worden gebo-ren, elk 1.400 gram. Eén...

Een primigravida zwanger van een monochoriale monoam-niotische (MCMA) tweeling, wordt doorverwezen naar onze MIC-afdeling op een amenorroeduur van 27 weken omwille van premature contracties. De cervixlengte is 15mm. MCMA tweelingen vertegenwoordigen 1% van de mo-nozygote tweelingen. De meest specifieke complicatie is een navelstrengverstrengeling, oorzaak van 50% van de foetale sterftes. Het vaststellen van een navelstreng-verstrengeling is een moeilijke prenatale diagnose (1, 2). Op een amenorroeduur van 29 weken en 5 dagen wordt op 3D color dopplerechografie een verstrengeling van beide navelstrengen vermoed (Figuur 1), alsook een ge-associeerd oligohydramnion (3). Patiënte krijgt 3-maal daags foetale monitoring met dagelijks biofysisch pro-fiel met dopplers. Binnen de 24 uur na echografie zet de premature arbeid zich door en wordt er overgegaan tot dringende sectio caesarea. De navelstrengverstrengeling wordt bevestigd (Figuur 2). Twee meisjes worden gebo-ren, elk 1.400 gram. Eén...

Background Observational data from the retrospective, non-randomized Pregnancy REmote MOnitoring I (PREMOM I) study showed that remote monitoring (RM) may be beneficial for prenatal observation of women at risk for gestational hypertensive disorders (GHD) in terms of clinical outcomes, health economics, and stakeholder perceptions. PREMOM II is a prospective, randomized, multicenter follow-up study that was performed to explore these promising results. Methods After providing written consent, 3922 pregnant women aged ≥18 years who are at increased risk of developing GHD will be randomized (1:1:1 ratio) to (a) conventional care (control group), (b) a patient self-monitoring group, and (c) a midwife-assisted RM group. The women in each group will be further divided (1:1 ratio) to evaluate the outcomes of targeted or non-targeted (conventional) antihypertensive medication. Women will be recruited in five hospitals in Flanders, Belgium: Ziekenhuis Oost-Limburg, Universitaire Ziekenhuis ...

Background: The expansion of the obesity epidemic is accompanied with an increase in bariatric procedures, in particular in women of reproductive age. The weight loss induced by the surgery is believed to reverse the negative impact of overweight and obesity on female reproduction, however, research is limited to in particular retrospective cohort studies and a growing number of small case-series and case-(control) studies. Methods/design: AURORA is a multicenter prospective cohort study. The main objective is to collect long-term data on reproductive outcomes before and after bariatric surgery and in a subsequent pregnancy. Women aged 18-45 years are invited to participate at 4 possible inclusion moments: 1) before surgery, 2) after surgery, 3) before 15 weeks of pregnancy and 4) in the immediate postpartum period (day 3-4). Depending on the time of inclusion, data are collected before surgery (T1), 3 weeks and 3, 6, 12 or x months after surgery (T2-T5) and during the first, second and third trimester of pregnancy (T6-T8), at delivery (T9) and 6 weeks and 6 months after delivery (T10-T11). Online questionnaires are send on the different measuring moments. Data are collected on contraception, menstrual cycle, sexuality, intention of becoming pregnant, diet, physical activity, lifestyle, psycho-social characteristics and dietary supplement intake. Fasting blood samples determine levels of vitamin A, D, E, K, B-1, B-12 and folate, albumin, total protein, coagulation parameters, magnesium, calcium, zinc and glucose. Participants are weighted every measuring moment. Fetal ultrasounds and pregnancy course and complications are reported every trimester of pregnancy. Breastfeeding is recorded and breast milk composition in the postpartum period is studied. Discussion: AURORA is a multicenter prospective cohort study extensively monitoring women before undergoing bariatric surgery until a subsequent pregnancy and postpartum period.

Participation in scientific or experimental research as an initiator, principal investigator or researcher: Chantelle Garritty; Laura Gaudet; Liesbeth Lewi (academic studies e.g. studies in monochorionic twins); Kristien Roelens, Geert Page Grants, fees or funds for a member of staff or another form of compensation for the execution of research: Wilfried Gyselaers (Promotor PHD's : IWT and LCRP-project at University Hasselt) Payments to speak, training remuneration, subsidised travel or payment for participation at a conference: Bart Van Overmeire (IPOKRaTES courses), Geert Page (lectures on EBM for LOK's; Urology congresses), Roland Van Dijck (participation congress) Presidency or accountable function within an institution, association, department or other entity on which the results of this report could have an impact: Anita Verhille (board member VVOC), Trinette Dirikx (board member VVOC), Yannic Verhaest (board member VVOC), Geert Page (member of VVOG) Other possible interests that could lead to a potential or actual conflict of interest: Anita Verhille, Trinette Dirikx, Yannic Verhaest Further, it should be noted that all experts and stakeholders, as well as the validators consulted within this report were selected because of their expertise in the field of preterm birth. Therefore, by definition, all consulted experts, stakeholders and validators have a certain degree of conflict of interest to the main topic of this report. Layout: Ine Verhulst Disclaimer:  The external experts were consulted about a (preliminary) version of the scientific report. Their comments were discussed during meetings. They did not co-author the scientific report and did not necessarily agree with its content.  Subsequently, a (final) version was submitted to the validators. The validation of the report results from a consensus or a voting process between the validators. The validators did not co-author the scientific report and did not necessarily all three agree with its content.  Finally, this report has been approved by common assent by the Executive Board.

Background Stillbirth has been recognized as a possible complication of a SARS-CoV-2 infection during pregnancy, probably due to destructive placental lesions (SARS-CoV-2 placentitis). The aim of this work is to analyse stillbirth and late miscarriage cases in unvaccinated pregnant women infected with SARS-CoV-2 during the first two waves (wild-type period) in Belgium. Methods Stillbirths and late miscarriages in our prospective observational nationwide registry of SARS-CoV-2 infected pregnant women (n = 982) were classified by three authors using a modified WHO-UMC classification system for standardized case causality assessment. Results Our cohort included 982 hospitalised pregnant women infected with SARS-CoV-2, with 23 fetal demises (10 late miscarriages from 12 to 22 weeks of gestational age and 13 stillbirths). The stillbirth rate was 9.5‰ for singleton pregnancies and 83.3‰ for multiple pregnancies, which seems higher than for the background population (respectively 5.6‰ and ...

Background: Anxiety and depression levels are higher in obese compared to normal weight pregnant women. The aim of this study is to examine anxiety and depression in pregnancy following bariatric surgery, and to compare with obese pregnant controls considering the dietary intake of polyunsaturated fatty acids (PUFA), folate and vitamin B-12. Methods: Anxiety (State-Trait Anxiety Inventory) and depression (Edinburgh Postnatal Depression Scale) were examined in the first (T1) and third (T3) pregnancy trimester in 54 women with bariatric surgery and 25 obese. T1 and T3 dietary intake of PUFA, folate and vitamin B-12 intake was assessed using a 3-day food record. Mixed models with a compound symmetry covariance structure and regression models were applied. Results: About half of the women with surgery had high state and trait anxiety scores (≥40), which did not significantly change during pregnancy. Every ten kilogram postoperative weight loss was associated with an increase in T1 state and trait anxiety with respectively 2.7 and 2.3 points. A smoking woman had a 8.6 point higher state anxiety score than a non-smoking woman in T1. In T3, every additional hour of sleep was associated with a decrease in trait anxiety score with 1.59 points. Anxiety and depression scores were not associated with and could not be explained by inadequate PUFAs, folate and vitamin B-12 intakes. Anxiety scores were higher following surgery than in untreated obesity at both time points. Conclusion: Pregnancy following bariatric surgery induces high levels of anxiety, that are not associated with an inadequate maternal diet.

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Background: The expansion of the obesity epidemic is accompanied with an increase in bariatric procedures, in particular in women of reproductive age. The weight loss induced by the surgery is believed to reverse the negative impact of overweight and obesity on female reproduction, however, research is limited to in particular retrospective cohort studies and a growing number of small case-series and case-(control) studies. Methods/design: AURORA is a multicenter prospective cohort study. The main objective is to collect long-term data on reproductive outcomes before and after bariatric surgery and in a subsequent pregnancy. Women aged 18-45 years are invited to participate at 4 possible inclusion moments: 1) before surgery, 2) after surgery, 3) before 15 weeks of pregnancy and 4) in the immediate postpartum period (day 3-4). Depending on the time of inclusion, data are collected before surgery (T1), 3 weeks and 3, 6, 12 or x months after surgery (T2-T5) and during the first, second and third trimester of pregnancy (T6-T8), at delivery (T9) and 6 weeks and 6 months after delivery (T10-T11). Online questionnaires are send on the different measuring moments. Data are collected on contraception, menstrual cycle, sexuality, intention of becoming pregnant, diet, physical activity, lifestyle, psycho-social characteristics and dietary supplement intake. Fasting blood samples determine levels of vitamin A, D, E, K, B-1, B-12 and folate, albumin, total protein, coagulation parameters, magnesium, calcium, zinc and glucose. Participants are weighted every measuring moment. Fetal ultrasounds and pregnancy course and complications are reported every trimester of pregnancy. Breastfeeding is recorded and breast milk composition in the postpartum period is studied. Discussion: AURORA is a multicenter prospective cohort study extensively monitoring women before undergoing bariatric surgery until a subsequent pregnancy and postpartum period.

Participation in scientific or experimental research as an initiator, principal investigator or researcher: Chantelle Garritty; Laura Gaudet; Liesbeth Lewi (academic studies e.g. studies in monochorionic twins); Kristien Roelens, Geert Page Grants, fees or funds for a member of staff or another form of compensation for the execution of research: Wilfried Gyselaers (Promotor PHD's : IWT and LCRP-project at University Hasselt) Payments to speak, training remuneration, subsidised travel or payment for participation at a conference: Bart Van Overmeire (IPOKRaTES courses), Geert Page (lectures on EBM for LOK's; Urology congresses), Roland Van Dijck (participation congress) Presidency or accountable function within an institution, association, department or other entity on which the results of this report could have an impact: Anita Verhille (board member VVOC), Trinette Dirikx (board member VVOC), Yannic Verhaest (board member VVOC), Geert Page (member of VVOG) Other possible interests that could lead to a potential or actual conflict of interest: Anita Verhille, Trinette Dirikx, Yannic Verhaest Further, it should be noted that all experts and stakeholders, as well as the validators consulted within this report were selected because of their expertise in the field of preterm birth. Therefore, by definition, all consulted experts, stakeholders and validators have a certain degree of conflict of interest to the main topic of this report. Further, it should be noted that all experts and stakeholders, as well as the validators consulted within this report were selected because of their expertise in the field of preterm birth. Therefore, by definition, all consulted experts, stakeholders and validators have a certain degree of conflict of interest to the main topic of this report. Layout: Ine Verhulst Disclaimer: The external experts were consulted about a (preliminary) version of the scientific report. Their comments were discussed during meetings. They did not co-author the scientific report and did not necessarily agree with its content. Subsequently, a (final) version was submitted to the validators. The validation of the report results from a consensus or a voting process between the validators. The validators did not co-author the scientific report and did not necessarily all three agree with its content. Finally, this report has been approved by common assent by the Executive Board. Only the KCE is responsible for errors or omissions that could persist. The policy recommendations are also under the full responsibility of the KCE.